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1.
Neurosurgery ; 90(4): 383-389, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35132970

RESUMO

BACKGROUND: Intracranial hemorrhage (ICH) is considered an emergency that requires rapid medical or surgical management. Previous studies have used artificial intelligence to attempt to expedite the diagnosis of this pathology on neuroimaging. However, these studies have used local, institution-specific data for training of networks that limit deployment of across broader hospital networks or regions because of data biases. OBJECTIVE: To demonstrate the creation of a neural network based on an openly available imaging data tested on data from our institution demonstrating a high-efficacy, institution-agnostic network. METHODS: A data set was created from publicly available noncontrast computed tomography images of known ICH. These data were used to train a neural network using distinct windowing and augmentation. This network was then validated in 2 phases using cohort-based (phase 1) and longitudinal (phase 2) approaches. RESULTS: Our convolutional neural network was trained on 752 807 openly available slices, which included 112 762 slices containing intracranial hemorrhage. In phase 1, the final network performance for intracranial hemorrhage showed a receiver operating characteristic curve (AUC) of 0.99. At the inflection point, our model showed a sensitivity of 98% at a threshold specificity of 99%. In phase 2, we obtained an AUC of 0.98 after analysis of 726 scans with a negative predictive value of 99.70% (n = 726). CONCLUSION: We demonstrate an effective neural network trained on completely open data for screening ICH at an unrelated institution. This study demonstrates a proof of concept for screening networks for multiple sites while maintaining high efficacy.


Assuntos
Inteligência Artificial , Redes Neurais de Computação , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Neuroimagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Clin Anat ; 35(4): 477-481, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34877709

RESUMO

Although superior gluteal nerve (SGN) injury can have significant morbidity, to date, surgical strategies for its repair are scant in the literature. Specifically, neurotization options have not been explored. To address this deficiency in the literature, the current cadaveric feasibility study was performed. Via a transgluteal approach on 16 cadaveric sides, the proximal sciatic nerve and the entrance of the SGN into the gluteus medius and minimus were identified. Additionally, branches from the sciatic nerve to the hamstring muscles were traced proximally to confirm their position in relation to the sciatic nerve as a whole. These branches were cut at the level of the ischial tuberosity and teased away from the sciatic nerve proximally to the greater sciatic foramen and transferred superolateral to the SGN. The diameter of each nerve branch was measured as well as its available length for reaching the SGN. All branches of the sciatic nerve to the hamstring muscles arose from the anteromedial part of the nerve. The mean diameters of the branches to the semimembranosus, semitendinosus, and biceps femoris muscles were 2.1, 1.9, and 1.5 mm, respectively. The mean diameter of the SGN was 3.1 mm and the mean distance from this entrance point to the ischial spine was 7.2 cm. The mean length of the donor nerve was 8.5 cm. Based on our study, use of a tibial-innervated hamstring branch as a donor for nerve transfer to the SGN is feasible.


Assuntos
Músculos Isquiossurais , Transferência de Nervo , Cadáver , Estudos de Viabilidade , Humanos , Nervo Isquiático/anatomia & histologia
4.
Childs Nerv Syst ; 38(4): 821-825, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34235553

RESUMO

BACKGROUND: Chiari malformation (CM) type 1 is characterized by descent of the cerebellar tonsils resulting from crowding of the posterior fossa. In 30% of cases, it is associated with syringomyelia. When symptomatic, it may result in a classic constellation of symptoms. CASE PRESENTATION: Here we describe a case of a 16-year-old male who presented with isolated, unilateral foot drop due to CM type 1 and holosyrinx. This unique presentation is extremely rare, and we additionally present a review of all other reported cases in the literature. After undergoing posterior fossa decompression with C1 laminectomy and duraplasty, our patient made a complete neurological recovery within 2 weeks postoperatively and his MRI entire spine at 3 months postoperatively demonstrated a nearly complete resolution of the holosyrinx with significant decompression of the foramen magnum. CONCLUSION: This rare presentation highlights the importance of maintaining a broad differential, particularly in pediatric patients, and expediting the workup in order to offer a surgical decompression within 1-2 months of foot weakness to maximize the probability of a full neurological recovery.


Assuntos
Malformação de Arnold-Chiari , Neuropatias Fibulares , Siringomielia , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/métodos , Forame Magno/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Siringomielia/cirurgia
5.
World Neurosurg ; 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34775090

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) for anterior circulation stroke has been proven to be highly effective. In comparison, MT for basilar artery occlusion (BAO) continues to lack definitive evidence of efficacy. The main MT modalities are stent retriever (SR) and direct aspiration (DA). Several studies have been published comparing the 2 approaches. OBJECTIVE: We sought to directly compare and synthesize safety and efficacy outcomes with SR versus DA for acute BAO. METHODS: A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: Overall, 8 studies comprising 693 patients with BAO were included (SR: 457; DA: 236). The SR group was associated with statistically significant lower odds of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.31-0.94) and mTICI3 (OR: 0.47; 95% CI: 0.23-0.95) compared with DA. Favorable outcome rates were similar between the 2 groups (OR: 0.83; 95% CI: 0.60-1.16). The rates of symptomatic intracerebral hemorrhage (OR: 3.57; 95% CI: 0.75-16.95), subarachnoid hemorrhage (SAH) (OR: 4.71; 95% CI: 0.82-26.90), and vessel perforation (OR: 2.64; 95% CI: 0.43-16.33) were higher in the SR group, but statistical significance was not reached. The rates of 90-day mortality were similar between the 2 groups (OR: 1.07; 95% CI: 0.67-1.70). Procedure duration was significantly shorter when DA was used compared with SR (weighted mean difference: 26.10 minutes; 95% CI: 13.28-38.92). CONCLUSIONS: SR is associated with statistically significant lower odds of mTICI 2b/3 and mTICI 3 recanalization rates compared with DA. SR appears to be associated with a higher complication rate, but significance was not reached.

6.
J Neurosurg Spine ; : 1-6, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598154

RESUMO

OBJECTIVE: Neurolymphomatosis (NL) is a rare manifestation of lymphoma confined to the peripheral nervous system that is poorly understood. It can be found in the cauda equina, but extraspinal disease can be underappreciated. The authors describe how extraspinal NL progresses to the cauda equina by perineural spread and the implications of this on timely and safe diagnostic options. METHODS: The authors used the Mayo Clinic medical records database to find cases of cauda equina NL with sufficient imaging to characterize the lumbosacral plexus diagnosed from tissue biopsy. Demographics (sex, age), clinical data (initial symptoms, cerebrospinal fluid, evidence of CNS involvement, biopsy location, primary or secondary disease), and imaging findings were reviewed. RESULTS: Ten patients met inclusion and exclusion criteria, and only 2 of 10 patients presented with cauda equina symptoms at the time of biopsy, with 1 patient undergoing a cauda equina biopsy. Eight patients were diagnosed with diffuse large B-cell lymphoma, 1 with low-grade B-cell lymphoma, and 1 with mantle cell lymphoma. Isolated spinal nerve involvement was identified in 5 of 10 cases, providing compelling evidence regarding the pathophysiology of NL. The conus medullaris was not radiologically involved in any case. Lumbosacral plexus MRI was able to identify extraspinal disease and offered diagnostically useful biopsy targets. FDG PET/CT was relatively insensitive for detecting disease in the cauda equina but was helpful in identifying extraspinal NL. CONCLUSIONS: The authors propose that perineural spread of extraspinal NL to infiltrate the cauda equina occurs in two phases. 1) There is proximal and distal spread along a peripheral nerve, with eventual spread to anatomically connected nerves via junction and branch points. 2) The tumor cells enter the spinal canal through corresponding neural foramina and propagate along the spinal nerves composing the cauda equina. To diffusely infiltrate the cauda equina, a third phase occurs in which tumor cells can spread circumdurally to the opposite side of the spinal canal and enter contralateral nerve roots extending proximally and distally. This spread of disease can lead to diffuse bilateral spinal nerve disease without diffuse leptomeningeal spread. Recognition of this phasic mechanism can lead to identification of safer extraspinal biopsy targets that could allow for greater functional recovery after appropriate treatment.

7.
Heliyon ; 7(8): e07766, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34430744

RESUMO

Spinal oncology has had many advancements often necessitating serial imaging for post-surgical treatment planning and close follow up. Traditional spinal instrumentation introduces artifact into MRI and CT imaging, which can reduce the efficacy of follow up imaging and treatment. Newly created carbon-fiber instrumentation can offer many advantages compared to traditional instrumentation while typically maintaining biomechanical stability. The utility of this new instrumentation continues to evolve as more surgeons utilize these materials, which can improve patient outcomes. We illustrate the utility of this new hardware technology through various patient examples.

8.
World Neurosurg ; 154: e707-e709, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34343683

RESUMO

Von Hippel-Lindau (VHL) disease is a multisystem disease cause by germline mutations of the VHL tumor suppressor gene. Hemangioblastomas are the most common manifestation of VHL disease and can occur in the central nervous system in up to 90% of these patients. By contrast, we found only one true case of a peripheral nervous system (PNS) hemangioblastoma in the setting of VHL. We explore the possible reasons behind the lack of PNS hemangioblastomas in VHL disease.


Assuntos
Neoplasias Cerebelares/complicações , Hemangioblastoma/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Doença de von Hippel-Lindau/complicações , Humanos
10.
World Neurosurg ; 145: 98-101, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32916345

RESUMO

BACKGROUND: Subungual melanoma (SUM) is a rare form of melanoma confined to the nailbed and is rarely of the desmoplastic subtype. The often subtle nature of SUM, initially starting as a small dark spot or line in the nailbed, means deeper invasion can occur before a patient seeks clinical evaluation for a large, ulcerated lesion. We report the only known case of perineural spread of SUM of the lower extremity and describe its extensive path of perineural spread from the toe. CASE DESCRIPTION: A 72-year-old man with a distant history of SUM status post second ray amputation, presented for evaluation of ipsilateral foot drop. Imaging revealed nodular involvement of tibial, peroneal, and sciatic nerves. Biopsies revealed desmoplastic melanoma and he was treated with nivolumab. CONCLUSIONS: We report the only known case of perineural spread of SUM of the lower extremity and describe the pathoanatomy of perineural spread. A high index of suspicion for recurrent disease should be maintained even many years after completion of treatment.


Assuntos
Melanoma/patologia , Doenças da Unha/patologia , Neoplasias/patologia , Amputação , Antineoplásicos/uso terapêutico , Biópsia , Eletromiografia , Humanos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Imageamento por Ressonância Magnética , Masculino , Melanoma/cirurgia , Melanoma/terapia , Pessoa de Meia-Idade , Doenças da Unha/cirurgia , Doenças da Unha/terapia , Neoplasias/cirurgia , Neoplasias/terapia , Nivolumabe/uso terapêutico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Resultado do Tratamento
12.
J Craniofac Surg ; 32(1): 62-66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33136783

RESUMO

BACKGROUND: Posterior cranial vault distraction (PCVD) is a well-established procedure to treat infants with craniosynostosis. Craniofacial surgeons have seen an evolution in the complications following PCVD. This report aims to demonstrate the rates of common complications from PCVD, and to identify strategies for prevention and management of these complications. METHODS: A formal literature review of studies on postoperative complications from PCVD was conducted to identify the breadth of reported complications from PCVD and rates of occurrence. RESULTS: A total of 776 articles were captured by our search strategy. Nineteen original articles met inclusion criteria, with a total of 342 patients. The average rate of reported complications was 25%, range (0%-100%). The most commonly reported complication was postoperative infection (23.7%), followed by cerebrospinal fluid leak (20.3%) and device failure (15.3%). Postoperative infection, device exposure, iatrogenic vascular injury, cerebrospinal fluid leak, and other complications have the potential to disrupt distraction and increase morbidity and mortality. CONCLUSIONS: By continuing to identify and evaluate complications, prevention strategies can be determined and standardized to decrease complications from PCVD. These efforts uphold the ultimate goal for surgeons involved in the treatment of craniosynostosis: to provide safe, effective surgical care.


Assuntos
Osteogênese por Distração , Crânio , Cirurgiões , Vazamento de Líquido Cefalorraquidiano , Craniossinostoses/cirurgia , Humanos , Osteogênese por Distração/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle
13.
BMJ Simul Technol Enhanc Learn ; 7(6): 635-637, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35520956

RESUMO

Lumbar drain insertion is a common procedure that is performed by anaesthesiologists, radiologists and neurosurgeons that is generally taught through supervised learning that can place patients at risk. We describe in detail the creation and considerations of a novel lumbar drain simulator designed to allow learners to rehearse the complete lumbar drain insertion procedure from start to finish. A lumbar drain simulator was designed with the goal of simulating drain placement on a patient including identifying physical landmarks, sterile field preparation, technical steps of the procedure, troubleshooting and securing and connecting the drainage system. Emphasis was placed on simulating the structural components of the anatomic compartments encountered during needle insertion and accurate reproduction of the tactile aspects of the procedure. The simulator is able to reproduce the critical aspects of drain placement, allowing for learners to practice a complete lumbar drain placement from start to finish. A complete simulation of lumbar drain placement can be created that allows learners to practise all aspects of the lumbar drain procedure. Learners can rehearse all steps of the procedure allowing them to be more confident and facile with the procedure, which can lead to improved patient safety and satisfaction.

14.
Neurosurg Focus ; 49(5): E2, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33130621

RESUMO

Annually, 20% of all practicing neurosurgeons in the United States are faced with medical malpractice litigation. The average indemnity paid in a closed neurosurgical civil claim is $439,146, the highest of all medical specialties. The majority of claims result from dissatisfaction following spinal surgery, although claims after cranial surgery tend to be costlier. On a societal scale, the increasing prevalence of medical malpractice claims is a catalyst for the practice of defensive medicine, resulting in record-level healthcare costs. Outside of the obvious financial strains, malpractice claims have also been linked to professional disenchantment and career changes for afflicted physicians. Unfortunately, neurosurgical residents receive minimal practical education regarding these matters and are often unprepared and vulnerable to these setbacks in the earlier stages of their careers. In this article, the authors aim to provide neurosurgical residents and junior attendings with an introductory guide to the fundamentals of medical malpractice lawsuits and the implications for neurosurgeons as an adjunct to more formal residency education.


Assuntos
Imperícia , Neurocirurgia , Médicos , Humanos , Neurocirurgiões , Estados Unidos
15.
Acta Neurochir (Wien) ; 162(12): 3179-3187, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32632655

RESUMO

BACKGROUND: Perineural spread (PNS) is an emerging mechanism for progressive, non-traumatic brachial plexopathy. We aim to summarize the pathologies (tumor and infection) shown to have spread along or to the brachial plexus, and identify the proposed mechanisms of perineural spread. METHODS: A focused review of the literature was performed pertaining to pathologies with identified perineural spread to the brachial plexus. RESULTS: We summarized pathologies currently reported to have PNS in the brachial plexus and offer a structure for understanding and describing these pathologies with respect to their interaction with the peripheral nervous system. CONCLUSIONS: Perineural spread is an underrepresented entity in the literature, especially regarding the brachial plexus. It can occur via a primary or secondary mechanism based on the anatomy, and understanding this mechanism helps to support biopsies of sacrificial nerve contributions, leading to more effective and timely treatment plans for patients.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/fisiopatologia , Plexo Braquial/fisiopatologia , Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/diagnóstico por imagem , Humanos , Hanseníase/complicações , Imageamento por Ressonância Magnética , Neoplasias/complicações , Tuberculose/complicações
16.
World Neurosurg ; 141: e490-e497, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32492544

RESUMO

BACKGROUND: The diagnosis of peripheral neurolymphomatosis (NL) is difficult and often delayed, because patients can have isolated, nonspecific nerve symptoms. Magnetic resonance imaging will usually show nonspecific findings of enlarged, contrast-enhancing nerves. We aimed to elucidate the mechanism behind an imaging finding we believe is pathognomonic of NL and likely of other hematologic diseases with peripheral nerve involvement. METHODS: We reviewed the imaging studies of a previously reported cohort of patients, in addition to those from more recent patients, all with tumefactive NL, in which enlarged nerve bundles were surrounded by tumor. We reviewed the demographic data, clinical data (e.g., primary or secondary disease, biopsy-proven diagnosis), and imaging findings (e.g., tumefactive appearance, primary involved nerve, location of epicenter of tumefactive appearance, vascular involvement). RESULTS: All cases showed a maximum tumefactive appearance at branch or junction points, with a gradual decrease of this appearance moving proximally and distally from the epicenter in a "crescendo-decrescendo" pattern. We have described this as a phasic mechanism with 3 phases: malignant cells fill the intraneural space; extrude at a weak spot of the nerve, which often occurs at a branch or junction point; and then expand and fill the subparaneurial space, creating the grossly tumefactive appearance with proximal and distal spread. CONCLUSIONS: We have presented a novel, unifying theory explaining the pathognomonic tumefactive appearance of NL. Our theory offers the first rational explanation for the radiological appearance of NL with peripheral nerve involvement. We believe that with earlier recognition of NL on imaging studies, patients will be able to receive an earlier diagnosis and undergo earlier treatment.


Assuntos
Neurolinfomatose/diagnóstico por imagem , Neurolinfomatose/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
18.
World Neurosurg ; 141: 323-326, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32592970

RESUMO

BACKGROUND: Adenocarcinomas of müllerian origin are malignancies derived from tissues of the proximal third of the vagina, cervix, uterus, and fallopian tubes. These organs develop from the embryologic müllerian ducts. While reports of perineural spread of certain uterine and cervical carcinomas exist in the literature, to our knowledge, no reports of clear cell-type müllerian adenocarcinoma presenting with neural invasion of the lumbosacral plexus exist in the literature. CASE DESCRIPTION: A 77-year-old woman with a remote history of hysterectomy and bilateral salpingo-oopherectomy for benign disease presented for evaluation of foot drop. We present clinical, electromyographic, and imaging findings of her condition, which revealed a diffuse intraneural lesion of the ipsilateral lumbosacral plexus. Percutaneous biopsy of the lesion confirmed nerve infiltrating clear cell adenocarcinoma of müllerian origin. CONCLUSIONS: We present the first case of adenocarcinoma of müllerian origin with confirmed perineural spread presenting with ipsilateral lower extremity weakness. This case illustrates the importance of recognizing potential perineural spread of gynecologic malignancies to avoid delay in treatment.


Assuntos
Adenocarcinoma de Células Claras/patologia , Carcinoma/patologia , Plexo Lombossacral/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Adenocarcinoma de Células Claras/diagnóstico , Idoso , Carcinoma/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Coluna Vertebral/patologia
19.
World Neurosurg ; 141: 363-366, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32599197

RESUMO

BACKGROUND: Neuritis ossificans (intraneural heterotopic ossification) is a rare disorder described as heterotopic ossification of a nerve. We describe the presentation and management of the first reported case of neuritis ossificans with diffuse brachial plexus involvement and review the literature. CASE DESCRIPTION: A 35-year-old man presented to our clinic for evaluation of right upper extremity weakness without history of trauma. He had significant, debilitating pain and magnetic resonance imaging demonstrated a complex contrast-enhancing mass with significant associated edema. Positron emission tomography demonstrated a 18F-fluorodeoxyglucose avid lesion within the brachial plexus that was confirmed by biopsy to be neuritis ossificans. The patient was treated with indomethacin and had clinical and radiologic improvement. CONCLUSIONS: We present the only case of diffuse, brachial plexus neuritis ossificans. Given the challenges of resecting neuritis ossificans in this region, we believe medical management for complex brachial plexus lesions should be considered first, unless the sequela of the disease is sufficiently prolonged or there is concern for permanent neurovascular compromise.


Assuntos
Plexo Braquial/cirurgia , Neurite (Inflamação)/cirurgia , Ossificação Heterotópica/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Adulto , Plexo Braquial/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Neurite (Inflamação)/patologia , Ossificação Heterotópica/patologia , Doenças do Sistema Nervoso Periférico/patologia , Tomografia por Emissão de Pósitrons/métodos
20.
J Neurosurg ; 134(5): 1610-1617, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32442979

RESUMO

OBJECTIVE: Intraoperative stimulation has emerged as a crucial adjunct in neurosurgical oncology, aiding maximal tumor resection while preserving sensorimotor and language function. Despite increasing use in clinical practice of this stimulation, there are limited data on both intraoperative seizure (IS) frequency and the presence of afterdischarges (ADs) in patients undergoing such procedures. The objective of this study was to determine risk factors for IS or ADs, and to determine the clinical consequences of these intraoperative events. METHODS: A retrospective chart review was performed for patients undergoing awake craniotomy (both first time and repeat) at a single institution from 2013 to 2018. Hypothesized risk factors for ADs/ISs in patients were evaluated for their effect on ADs and ISs, including tumor location, tumor grade (I-IV), genetic markers (isocitrate dehydrogenase 1/2, O 6-methylguanine-DNA methyltransferase [MGMT] promoter methylation, chromosome 1p/19q codeletion), tumor volume, preoperative seizure status (yes/no), and dosage of preoperative antiepileptic drugs for each patient. Clinical outcomes assessed in patients with IS or ADs were duration of surgery, length of stay, presence of perioperative deficits, and postoperative seizures. Chi-square analysis was performed for binary categorical variables, and a Student t-test was used to assess continuous variables. RESULTS: A total of 229 consecutive patients were included in the analysis. Thirty-five patients (15%) experienced ISs. Thirteen (37%) of these 35 patients had experienced seizures that were appreciated clinically and noted on electrocorticography simultaneously, while 8 patients (23%) experienced ISs that were electrographic alone (no obvious clinical change). MGMT promoter methylation was associated with an increased prevalence of ISs (OR 3.3, 95% CI 1.2-7.8, p = 0.02). Forty patients (18%) experienced ADs. Twenty-three percent of patients (9/40) with ISs had ADs prior to their seizure, although ISs and ADs were not statistically associated (p = 0.16). The presence of ADs appeared to be correlated with a shorter length of stay (5.1 ± 2.6 vs 6.1 ± 3.7 days, p = 0.037). Of the clinical features assessed, none were found to be predictive of ADs. Neither IS nor AD, or the presence of either IS or AD (65/229 patients), was a predictor for increased length of stay, presence of perioperative deficits, or postoperative seizures. CONCLUSIONS: ISs and ADs, while commonly observed during intraoperative stimulation for brain mapping, do not negatively affect patient outcomes.


Assuntos
Mapeamento Encefálico/efeitos adversos , Craniotomia , Eletrocorticografia/efeitos adversos , Complicações Intraoperatórias/etiologia , Monitorização Intraoperatória/efeitos adversos , Convulsões/etiologia , Adulto , Biomarcadores Tumorais , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Metilação de DNA , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Feminino , Humanos , Complicações Intraoperatórias/fisiopatologia , Isocitrato Desidrogenase/genética , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Regiões Promotoras Genéticas , Estudos Retrospectivos , Fatores de Risco , Convulsões/fisiopatologia , Carga Tumoral , Proteínas Supressoras de Tumor/genética , Vigília
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